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Evaluation of a new departmental policy to decrease routine opioid prescribing after vaginal delivery.

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New guidelines significantly reduced opioid prescriptions after vaginal delivery. This change did not lead to a significant increase in postpartum pain-related outpatient visits, supporting reduced opioid use.

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Area of Science:

  • Obstetrics and Gynecology
  • Pain Management
  • Public Health Policy

Background:

  • A nationwide initiative to decrease opioid prescribing prompted a policy change.
  • Routine opioid prescriptions at discharge after vaginal delivery were ceased in October 2017.

Purpose of the Study:

  • To evaluate the impact of a new policy on opioid discharge prescriptions.
  • To assess the effect of the policy on postpartum outpatient pain-related encounters.

Main Methods:

  • Retrospective cohort study of vaginal deliveries (November 2016 - January 2018).
  • Inclusion criteria: patients ≥18 years, no chronic opioid use, no contraindications to NSAIDs.
  • Outcomes: opioid discharge prescriptions and unscheduled postpartum pain encounters. Fisher's exact test used for comparison.

Main Results:

  • A 10-fold decrease in opioid discharge prescriptions was observed (79.8% to 7.2%, P<.01).
  • Unscheduled postpartum outpatient pain encounters slightly increased (22 to 37), but this was not statistically significant (P=.08).

Conclusions:

  • Limiting opioid prescribing after vaginal delivery substantially reduces discharge prescriptions.
  • This policy change does not significantly increase postpartum pain-related outpatient visits.